High post-ACS troponin at 4 months predicts CV death risk

  • Adamson PD & al.
  • Heart
  • 23 Jul 2019

  • International Clinical Digest
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Takeaway

  • Cardiac troponin at 4 months after an acute coronary syndrome (ACS) event predicts risk for cardiovascular (CV) death.
  • The 1 in 10 patients with highest values warrants close monitoring because of high risk (almost 10% annual incidence of cardiovascular death), with optimized cardiovascular care.

Why this matters

  • The role of testing high-sensitivity cardiac troponin in the months after an ACS has not been clear, but these results suggest potential for improving patient follow-up, say the authors.

Key results

  • Values were obtainable in 99.0% of patients at 4 months.
  • Troponin predicted cardiovascular death independently: HR, 1.4 (95% CI, 1.3-1.5 for each doubling in values).
  • Compared with patients with values ≤5 ng/L, those with values above the 99th percentile (9.3% of them at 4 months) had an almost 5-fold increased cardiovascular mortality risk: aHR, 4.9 (95% CI, 3.8-23.7).
  • Increases continuing to 12 months were also a red flag.
  • 5-year absolute incident risk by 4-month levels: 
    • >25% with >99th percentile.

Study design

  • Prospective, multicenter, observational study, 1776 patients with ACS event and no recurrence within 4 months.
  • Mean follow-up after 4-month troponin measure, 4.8 (maximum, 9.2) years.
  • Funding: Health Research Council of New Zealand, others.

Limitations

  • Observational study.